Diagnostic Criteria Even within clinical psychology, psychiatry and social work, there is much disparity and divergence about defining attachment disorders, Reactive Attachment Disorder, and attachment issues. What we know is that students display a variety of issues, levels of severity, and that support services and coordination with family or caregivers is important.  We also realize that many schools likely do not have attachment specialist teams or programs.  Helping services need to come from informed professionals coordinating with expert professionals, when  possible, and by applying the skills and resources they already have and coordinating with parents, teachers, and administrators for the best outcomes. Below is a summary of some diagnostic criteria regarding attachment issues.  This is not intended for diagnostic purposes, but rather to provide a reference framework within which to reference interventions and information.   Diagnostic Criteria for 313.89 Reactive Attachment Disorder of Infancy or Early Childhood A.   Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5, as evidenced by either (1) or (2):        1.  Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifested by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g.: the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting; or may exhibit a frozen watchfulness);        2.  Diffuse attachments as manifested by indiscriminate socialbility with marked inability to exhibit appropriate selective attachments (e.g.:  the child may exhibit excessive familiarity with relative strangers or lack selectivity in choice of attachment figures.) B.  The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive Developmental Disorder; C.  Pathogenic care as evidenced by at least one of the following:        1.  Persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection;        2.  Persistent disregard of the child's basic physical needs;      3.  Repeated changes of primary caregiver that prevent formation of stable attachments (e.g.: frequent changes in foster care); D.  There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g.: the disturbances in Criterion A began following the pathogenic care in Criterion C); E.  Inhibited vs. Disinhibited Type        1.  Inhibited Type:  If Criterion A1 predominates in the clinical relationship        2.  Disinhibited Type:  If Criterion A2 predominates in the clinical relationship.  309.81     Posttraumatic Stress Disorder  (PTSD) Diagnostic Features  The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life-threatening disease. The disorder may be especially severe or long lasting when the stressor is of human design (e.g., torture, rape). The likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event is replayed (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g. anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for a woman who was raped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situation, or people who arouse recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external world, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outbursts of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3). Specifiers The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder: Acute.  This specifier should be used when the duration of symptoms is less than 3 months. Chronic.  This specifier should be used when the symptoms last 3 months or longer. With Delayed Onset.  This specifier indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.   Complex - PTSD    Link to article Reprinted with the permission of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; copyright 1994, American Psychiatric Association.

Diagnostic Criteria Even within clinical psychology, psychiatry and social work, there is much disparity and divergence about defining attachment disorders, Reactive Attachment Disorder, and attachment issues. What we know is that students display a variety of issues, levels of severity, and that support services and coordination with family or caregivers is important.  We also realize that many schools likely do not have attachment specialist teams or programs.  Helping services need to come from informed professionals coordinating with expert professionals, when  possible, and by applying the skills and resources they already have and coordinating with parents, teachers, and administrators for the best outcomes. Below is a summary of some diagnostic criteria regarding attachment issues.  This is not intended for diagnostic purposes, but rather to provide a reference framework within which to reference interventions and information.   Diagnostic Criteria for 313.89 Reactive Attachment Disorder of Infancy or Early Childhood A.   Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5, as evidenced by either (1) or (2):        1.  Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifested by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g.: the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting; or may exhibit a frozen watchfulness);        2.  Diffuse attachments as manifested by indiscriminate socialbility with marked inability to exhibit appropriate selective attachments (e.g.:  the child may exhibit excessive familiarity with relative strangers or lack selectivity in choice of attachment figures.) B.  The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive Developmental Disorder; C.  Pathogenic care as evidenced by at least one of the following:        1.  Persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection;        2.  Persistent disregard of the child's basic physical needs;      3.  Repeated changes of primary caregiver that prevent formation of stable attachments (e.g.: frequent changes in foster care); D.  There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g.: the disturbances in Criterion A began following the pathogenic care in Criterion C); E.  Inhibited vs. Disinhibited Type        1.  Inhibited Type:  If Criterion A1 predominates in the clinical relationship        2.  Disinhibited Type:  If Criterion A2 predominates in the clinical relationship.  309.81     Posttraumatic Stress Disorder  (PTSD) Diagnostic Features  The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life-threatening disease. The disorder may be especially severe or long lasting when the stressor is of human design (e.g., torture, rape). The likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event is replayed (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g. anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for a woman who was raped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situation, or people who arouse recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external world, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outbursts of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3). Specifiers The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder: Acute.  This specifier should be used when the duration of symptoms is less than 3 months. Chronic.  This specifier should be used when the symptoms last 3 months or longer. With Delayed Onset.  This specifier indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.   Complex - PTSD    Link to article Reprinted with the permission of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; copyright 1994, American Psychiatric Association.